KENYA MEDICAL TRAINING COLLEGE

KNOWLEDGE, ATTITUDE AND PRACTICES IN SELF CARE

MANAGEMENT OF DIABETES TYPE 2 AMONG WOMEN 50 YRS AND

ABOVE ATTENDING DIABETIC CLINIC AT THIKA LEVEL 5

HOSPITAL.

PRESENTER

STUDENT NAME: BETH NJERI MBURU

COLLEGE NO: D/NURS/20005/459

CLASS SEPTEMBER 2019

SUBMITTED TO THE DEPARTMENT OF NURSING KENYA MEDICAL TRAINING

COLLEGE THIKA CAMPUS AS A PARTIAL FULFILMENT FOR THE AWARD OF
DIPLOMA IN COMMUNIY HEALTH NURSING

THIKA MEDICAL TRAINING COLLEGE

P.O BOX 729

THIKA.
Declaration

I, Beth Njeri , hereby declare that this research is my original work and can be only be used for

scholarly purpose

NAME Beth Njeri REG.NO D/NURS/20005/559

Signature…………………………………. Dates …………………………..

This research proposal has been submitted with the approval of the undersigned to the Kenya

Medical Training College - Thika Campus.

Supervisor Name……………………………………………………………………………

Signature……………………………………… Date……………………………………

ii
Acknowledgement

The work of carrying out this study needed adequate preparation and therefore called for

collective responsibilities of many people. The production of this research document has been

made possible by effects of many people within and outside K.M.T.C

I wish to thank the Almighty God who has been guiding me all through. Secondly, special thanks

to my parents and siblings who gave me moral and financial support throughout my school life.

Great gratitude goes to my research supervisor Mr Kirimi his professional guidance and

supervision throughout this study. My since gratitude also goes to training core team of

community health nursing department for their facilitation in research methodology and

epidemiology that made this study possible.

Also special thanks goes to all my colleagues who contributed to my research through their

constructive discussion.

Thank you all and may God bless.

iii
Table of Contents

Declaration......................................................................................................................................ii

Acknowledgement..........................................................................................................................iii

Abstract............................................................................................................................................6

Chapter One.....................................................................................................................................7

Introduction..............................................................................................................................7

1.1Background Information.....................................................................................................7

1.2Statement of the Problem....................................................................................................8

1.3Justification.........................................................................................................................9

1.4Objectives.........................................................................................................................10

1.5Research Questions...........................................................................................................10

Chapter 2 - Literature Review.......................................................................................................11

2.2 Level of management of diabetes type II........................................................................12

Chapter Three– Research Methodology........................................................................................20

3.1Study Area........................................................................................................................20

3.2Study Design.....................................................................................................................20

3.3Inclusion Criteria..............................................................................................................20

3.4Exclusion criteria..............................................................................................................20

3.5 Study Population..............................................................................................................21

3.6Data collection procedure.................................................................................................23

3.7 Data collection tools........................................................................................................23

3.8 Study Limitations.............................................................................................................23

3.9 Data management, analysis techniques and presentation................................................23

Chapter four...................................................................................................................................25

Data Analysis, Presentation and interpretation..............................................................................25

iv
 4.1Introduction.......................................................................................................................25

4.2 Demographic Data...........................................................................................................25

4.2.2 Table II: Level of education of the respondents...........................................................26

RESPONDENTS SOURCE OF INCOME...................................................................................27

4.2.4 Respondents Religion...................................................................................................27

Respondents Religion....................................................................................................................28

4.3 Knowledge on self care management of diabetes type II among women ove 50 years of
age..........................................................................................................................................28

4.3.1 Constotuents involved in the self care management of diabetes type II.......................28

4.4 ATTITUDE TOWARDS SELF CARE MANAGEMNT OF DIABETES TYPE II......31

4.5 Self Care management practices of diabetes Type II......................................................34

Resposndents place of measuring blood glucose...........................................................................36

Chapter five – Discussion and Interpretation................................................................................37

5.1Introduction.......................................................................................................................37

5.2 Discussion on how level of knowledge affects self care management of Diabetes........37

5.1 Discussing on attitude towards self management of diabetes type II..........................38

5.3How self Care Management Prectices affect diabetes management................................38

References......................................................................................Error! Bookmark not defined.

v
Abstract

Diabetes Mellitus is a chronic condition that arises when the pancreases does not produce enough

insulin, or when the body cannot effectively use the insulin produced. When a person has diabetes,

either their pancreases does not produce sufficient insulin needed by the body or their body cannot

make effective use of the insulin produced resulting to type 2 Diabetes (Albert, K et al , 2008) The

objectives of the study were To determine the level of knowledge , attitude and practices in self care

management of diabetes type II. Among women 50 years and above attending diabetic clinic at thika

level 5 hospital. To assess the knowledge in self care management of diabetes type II among women

over 50 years. To determine the attitude in self care management of diabetes type II among women 50

years and above. To determine the self care management practices of diabetes type II among women

over 50 years. The study will be conducted at thika level 5 hospital, which is a county referral hospital

situated in kiambu county. The study area will be suitable as it serves patients from the county thus

expected to have patients from diverse regions and socio economic status. The area has a daily mini

diabetic clinic from 8.00am to 1.00pm and a main clinic on Friday from 0800 hours to 1300 hours, The

study targeted a sample of 44 respondents. Out of the 44, 40 participated by completing and returning

the questionnaire and this was 90.0% response rate. This response rate was sufficient and

representative and conforms to Mugenda and Mugenda ( 2003) stipulation that a response rate of 50%

is adequate for reporting and analysis.

6
Chapter One

Introduction

1.1Background Information

Diabetes Mellitus is a chronic condition that arises when the pancrease does not produce enough

insulin, or when the body cannot effectively use the insulin produced. When a person has diabetes,

either their pancrease does not produce sufficient insulin needeb by the body or their body cannot

make effective use of the insulin produced resulting to type 2 Diabetes (Albert, K et al , 2008)

Diabetes Mellitus Type II has emerged as one of the most challenging public health problem in the 21 st

century. In many settings, ageing women do not have tha same access to health care as men or younger

women. In kenya for instance, the World Health Organization (WHO) estimates that prevalence of

diabetes in Kenya is 3.3% and predicts a rise to 4.5% by the year 2025 WHO ( 2011).

The barriers to primary health care faced by older people are often worse. These barriers include lack

of transportation, low literacy level and lack of money to pay for services and medication. Because

women live longer than men, they are more likely to be alone in old age, thus policy makers and

practitioners should pay special attention to the gender complications of long term care policies and

programs (WHO) (2007).

Treatment of diabetes type II in Kiambu county or other parts of Kenya is fraught with problems.

Besides challenges related to diagnosis, care and treatment, there is lack of understanding and

knowledge about the disease among health care professionals and the general population ( Mc Feran,

2008). Since it’s a chronic disease that lasts for many years, people diagnosed with diabetes need
7
continuing access to proper medical care. These includes, medication such as insulin, equipment such

as glucometer and glucose measuring strips and most importantly the health care professionals should

have adequate training in the diagnosis and treatment of diabetes type II and its complications

(DLF,2010)

Most research carried out in Kiambu county has focused on those affected by diabetes type II as a

whole regardless of their gender or age. The objective of this study therefore is to address the gap by

forcussing specifically on women over 50 years of age with an aim of generating solutions that can be

utilized to resolve some of the challenges they face in the management of diabetes type II. The age of

50 year is thought to incorporate the chronological functional and social definitions of old in Kenya

and has been adapted by the WHO for it's minimum data set project. The age cut off has also been

used in other studies in Kenya (WHO, 2006)

1.2Statement of the Problem

Diabetes is a chronic condition that requires patients to continue their treatment for the rest of their

lives. The emphasis is usually on the self care management of the disease conditions through a tight

schedule of blood glucose and urine sugar monitoring, medication and adjustment to dietary

modification. Such a chronic condition necessitates competent self care, which can be developed from

a thorough understanding of the disease process by the patient and presupposes a need for some form

of diabetes type II education and counseling for the patient. For people with diabetes, the medical issue

is not the only area that requires management, but also, lifestyle, family, psychology, cultural and

economic issues also need attention.

Diabetes affects women in uniquely gendered ways, many of which are related to the underlying

determinants of health and social economic status. The Kenyan construction acknowledges that all age

8
groups have the right to equal access to health services. However, significant health disparities

continue to exist among diabetics. Stopping the diabetes epidemic includes halting health disparities

caused by age, sex and social economic factors. This study therefore aims at addressing the gaps in

knowledge by focusing on the knowledge, attitude and practices on self care management of diabetes

type II among women of 50 years and above attending diabetes clinic at thika level 5 hospital. The

findings will assist in generating policies that will ensure that there is prioritized allocation of

resources.

1.3Justification

The study carried out at thika level 5 hospital aims at providing findings that will assist in diabetes

type II management. Assessment of women's knowledge leves and self management practices about

diabetes type II is important in developing educational materials relevant to their age and sex.

The study will aim at determining the knowledge, attitude and practices on self care management of

diabetes type II. Thereby help In reducing morbidity and mortality associated with diabetes and

therefore improve the quality of life. The findings will also assist in priority setting for management of

diabetes type in older women by the ministry of health, health insurers and relevant non-governmental

organization

9
1.4Objectives

1.4.1Broad Objectives
To determine the level of knowledge , attitude and practices in self care management of diabetes type

II. Among women 50 years and above attending diabetic clinic at thika level 5 hospital.

1.4.2Specific Objectives
1. To assess the knowledge in self care management of diabetes type II among women over 50

years.

2. To determine the attitude in self care management of diabetes type II among women 50 years

and above.

3. To determine the self care management practices of diabetes type II among women over 50

years.

1.5Research Questions

1. What is the level of knowledge in self care management of diabetes type II among women of

over 50 years of age.

2. What is the attitude of women over 50 years on self care management of diabetes type II.

3. What are the self management practices of diabetes type II in women aged over 50 years.

10
Chapter 2 - Literature Review

2.1 Introduction

Diabetes Mellitus is a chronic condition that arises when the pancreases does not produce enough

insulin, or when the body cannot effectively use the insulin produced. When a person has diabetes,

either their pancreases does not produce sufficient insulin needed by the body or their body cannot

make effective use of the insulin produced resulting to type 2 Diabetes (Albert, K et al , 2008)

Diabetes Mellitus Type II has emerged as one of the most challenging public health problem in the 21 st

century. In many settings, ageing women do not have tha same access to health care as men or younger

women. In kenya for instance, the World Health Organization (WHO) estimates that prevalence of

diabetes in Kenya is 3.3% and predicts a rise to 4.5% by the year 2025 WHO ( 2011).

The barriers to primary health care faced by older people are often worse. These barriers include lack

of transportation, low literacy level and lack of money to pay for services and medication. Because

women live longer than men, they are more likely to be alone in old age, thus policy makers and

practitioners should pay special attention to the gender complications of long term care policies and

programs (WHO) (2007).

Treatment of diabetes type II in Kiambu county or other parts of Kenya is fraught with problems.

Besides challenges related to diagnosis, care and treatment, there is lack of understanding and

knowledge about the disease among health care professionals and the general population ( Mc Feran,

2008). Since it’s a chronic disease that lasts for many years, people diagnosed with diabetes need

continuing access to proper medical care. ( Forosa and Muscat , 2016)

11
2.2 Level of management of diabetes type II

The goals in managing patients with diabetes mellitus are to eliminate symptoms and to prevent, or at

least slow the development of complications (International Diabetes Federation, 2013). Micro-vascular

(eye and kidney disease) risk reduction is accomplished through control of glycemia and blood

pressure; macro-vascular (coronary, cerebrovascular, peripheral vascular) risk reduction, through

control of lipids and hypertension, smoking cessation, and metabolic and neurologic risk reduction

through control of glycemia. Diabetes care is best provided by a multidisciplinary team of health

professionals with expertise in diabetes, working in collaboration with the patient and family

(Mollentze, 2012). 2.8.1 Diet Diet management requires control and awareness of the types of

nutrients entering the digestive system, and hence allows indirectly, significant control over changes in

blood glucose levels (Walker, 2007). T2DM patients experience dramatic effects on their blood sugars

through controlling their diet, and some can fully control the disease by dietary 17 modification. As

diabetes can lead to many other complications, it is important to maintain blood sugars as close to

normal as possible and diet is the leading factor in this level of control (Ono, 2008). Therefore, the

caloric intake for diabetic persons must be limited to that which is necessary for maintaining a healthy

weight. 2.8.2 Physical activity/exercise Physical activity/exercise lowers blood sugar level by moving

sugar into the cells where it is used for energy making it easier for a diabetic to control their blood

glucose level. Muscles in turn use glucose without insulin while exercising and as a result, blood

glucose level goes down. It also makes insulin more effective thus insulin resistance goes down when

one exercises and body cells can use the glucose more effectively (Maina et al., 2011; KNDS, 2010).

Exercise helps people with T2DM avoid long-term complications, including arteriosclerosis which can

lead to a heart attack. The aim of activity is to get at least thirty (30) minutes of aerobic exercise most

days of the week. The exercises include; walking, jogging/running, swimming, cycling (Knowler et al.,

12
2002). 2.8.3 Blood glucose control. Proper blood glucose control refers to the diabetic’s ability to

maintain their blood glucose at normal levels (euglycemia) for persons with diabetes mellitus (Adams,

2008). Many of the long-term complications of diabetes, especially the micro-vascular complications,

result from many years of hyperglycemia (Adams, 2008). Blood sugar level is measured by means of a

glucose meter, with the result either in mg/dL (milligrams per deciliter in the USA) or mmol/L

(millimoles per litre in Canada and 18 Europe) of blood. The average normal person should have a

glucose level of between 4.5 to 7.0 mmol/L (80 to 125 mg/dL). Optimal management of diabetes

involves patients measuring and recording their own blood glucose levels. By keeping a diary of their

own blood glucose measurements and noting the effect of food and exercise, patients can modify their

lifestyle to better control their diabetes (Huang et al., 2007). For patients on insulin, their involvement

is important in achieving effective dosing and timing. Because blood sugar levels fluctuate throughout

the day and glucose records are imperfect indicators of these changes, the percentage of hemoglobin

which is glycosylated is used as a proxy measure of long-term glycemic control in clinical care of

people with diabetes. Perfect glycemic control would mean that glucose levels were always normal

(70–130 mg/dl, or 3.9-7.2 mmol/L) and indistinguishable from a person without diabetes (Huang et al.,

2007). Poor glycemic control refers to persistently elevated blood glucose and glycosylated

hemoglobin levels, which may range from 200–500 mg/dl (11- 28 mmol/L) and 9-15% or higher over

months and years before severe complications occur (Walker, 2007). 2.8.4 Personal (home) glucose

monitoring Control and outcomes of T2DM may be improved by patients using home glucose meters

to regularly measure their glucose levels (Huang et al., 2007). Glucose monitoring is both expensive

(largely due to the cost of the consumable test strips) and requires significant commitment on the part

of the patient. The effort and expense may be worthwhile for patients when they use the values to

sensibly adjust food, exercise, and oral medications or insulin. 19 These adjustments are generally

13
made by the patients themselves following training by a clinician or health care providers trained on

diabetes management. This reduces hospital admission of diabetic patients (Kibriya et al., 1999).

However, patients on oral medication who do not self-adjust their drug dosage will miss many of the

benefits of self-testing. Continuous Glucose Monitoring (CGM) technology has been rapidly

developing to give people living with diabetes an idea about the speed and direction of their glucose

changes (International Diabetes Federation, 2012). 2.8.5 Use of anti-diabetic drugs 2.8.5.1 Oral

medication. The most prevalent form of medication is hypoglycemic treatment by either oral

hypoglycemics including metformin, sulphonylureas, pioglitazone, and/or insulin therapy (Mealey,

2006). Metformin (Glucophage, Glumetza) is mainly the first medication prescribed for T2DM. These

diabetes medications stimulate the pancreas to produce and release more insulin, inhibit production

and release of glucose by the liver, thus one will require less insulin to transport sugar into the cells.

Other medications block the action of stomach or intestinal enzymes that break down carbohydrates or

make tissues more sensitive to insulin (National Institute for Health and Clinical Excellence, 2011).

Patient education and compliance with treatment is very important in managing the disease since

improper use of medications and insulin can be very dangerous causing hypo- or hyper-glycemic

episodes.

2.4 Self care management practices of diabetes type II

Self care is defined as the daily regimen of tasks that the individual performs to manage

diabetes (32). The American Association of Diabetic Educators has identified 7

components of self care activities that comprise useful skills and knowledge among

diabetic patients (33).

14
These self care practices include; healthy eating or medical nutrition therapy, regular

physical exercise, daily self monitoring of blood glucose, adherence to taking

medication, problem solving, reducing risks of complications of diabetes by cessation of

smoking, having regular eye, foot and dental examinations and healthy coping with the

disease. Healthy eating or medical nutrition therapy, physical exercise, self blood glucose

monitoring and medication taking are the self care behaviors that have been widely

studied as they impact directly on glycemic control.

Medical Nutrition Therapy is an integral component of diabetes prevention, management

and self management education. The recommendations from ADA are that it should be

individualized and be carried out by a dietician who is familiar with components of

therapy in order to achieve treatment goals(11). Due to the known effects of obesity on

insulin resistance, weight loss is an important therapeutic intervention for overweight

and obese individuals with pre diabetes or diabetes(34). Short term studies have shown

that moderate weight loss of 5% of body weight in patients with type 2 diabetes is

associated with a decrease in insulin resistance, improved measures of lipaemia,

glycemia and reduced blood pressure(35). Monitoring carbohydrates by counting,

estimation and appropriate choices is a key strategy in glycemic control(11). In the

UKPDS, subjects received 3 months of intensive nutrition therapy before randomization

that resulted in a 1.9% reduction in A1C and a mean 5 % weight loss(10). Other

15
recommendations include limiting saturated fats to < 7% of total calories. Evidence from the DASH

study which advocates for increased consumption of fruit and vegetables(8-10 servings per day), low

fat dairy products(2-3 servings per day), reducing sodium intake and limiting alcohol consumption to

less than one serving in females and two in males can also substantially lower blood pressure (36).

Hypertension is a common co morbidity among patients with diabetes.

Exercise plays an important part in diabetes management. Regular exercise has been shown to improve

blood glucose control, reduce cardiovascular risk factors, contribute to weight loss and improve well

being. ADA recommends at least 150 minutes per week of moderate intensity aerobic physical activity

that achieves 50 -70% of maximal heart rate. Structured exercise interventions of at least 8 weeks

duration have been shown to lower A1C by an average of 0.66% in people with type 2 diabetes even

with no significant change in Body Mass Index(37).

Higher levels of exercise intensity are associated with greater improvements in A1C and fitness(38).

There is additive benefit of combined aerobic and resistance exercise in adults with type 2

diabetes(39). Resistance exercise has been shown to be beneficial even in the older population with

type 2 diabetes(40) and is also recommended 3 times per week in the absence of contraindications.

16
Self monitoring of blood glucose has proved to be essential among patients with diabetes as it allows

them to evaluate their individual response to therapy and assess whether their glycemic targets are

being achieved. It is also useful in preventing hypoglycemia and adjusting medications, postprandial

insulin doses, medical nutrition therapy and physical exercise.

The optimal frequency and timing of Self Blood Glucose Monitoring in patients with type 2 diabetes

on non insulin therapy has remained controversial(41). Most studies have included several other self

care activities like diet, exercise and education making it difficult to assess the contribution of Self

Monitoring of Blood Glucose alone to glycemic control(42–44).

The approach to management of hyperglycemia in patients with diabetes has been elucidated in a

consensus statement by the ADA and EASD that has a combination of lifestyle interventions and

antidiabetic medication(45). Pharmacologic therapy for type 2 diabetes can facilitate excellent control

with the potential of normalization of A1C by insulin and a reduction of A1C by 0.5 to 2

% for oral antidiabetic medication (45). Despite the benefit of pharmacotherapy, adherence to

medication has been found to be poor, ranging from 36 to 85 % to oral medication(46–48).

Medication taking behavior has been well studied in patients with diabetes with verification of

adherence to medication having been assessed through medication electronic systems(49,50) and

patient questionnaires(26,51). Factors that have been found to adversely affect adherence to medication

are complexity of regimens(52), medication side effects, severity of depression(53) and the patients’

lack of belief in the immediate and future benefits of the medication prescribed. Insulin use presents

unique challenges including education on use, follow up and monitoring, fear of needles and regimen

complexity(54).

17
All patients with diabetes should be advised not to smoke due to the heightened risk of cardiovascular

events, premature death and increased rate of micro vascular complications. Routine thorough

assessment of tobacco use is an important way of preventing smoking and encouraging cessation.

Clinical trials have demonstrated reduction of tobacco use in patients from cost effective methods like

brief counseling(55).

Patients with diabetes should receive general foot care education and annual comprehensive foot

examination to identify risk factors predictive of foot ulcers and amputations(11). A multidisciplinary

approach is needed for those with high risk feet especially if they already have a history of previous

ulcer or amputation. Optimization of glycemic and blood pressure control is essential in reducing and

slowing down progression of retinopathy and nephropathy in these patients(10). Patients with type 2

diabetes should be screened for these complications at diagnosis and undergo follow up depending on

the progression of disease.

Although randomized control trials have shown that lifestyle interventions improve glycemic control,

translating these interventions into clinical practice and the daily lives of patients still remains a

challenge. Patients are unsupervised outside of clinical trials. Assessment of self care behaviors in

patients is difficult because of the complexities involved in trying to quantify the day to day activities

of patients in a measurable manner. The diverse socio cultural environments in which patients live in

also affect the certain self care behaviors like diet(56,57) and physical activity(23). Treatment

regimens are also individualized; there is no specific unchanging standard against which these

behaviors can be compared.

18
Few studies have evaluated self care practice among patients with type 2 diabetes in Africa.

This is in a background where formal diabetes education is lacking(58) and the level of

literacy in the population with type 2 diabetes is low. Ayele et al(59) in Ethiopia evaluated

the self care behaviour of 343 patients in Harari of which patients with type 2 diabetes were

66.2%. Self care behavior was assessed using the Self Care Inventory Revised (SCIR) scale

and found to be poor. Only 39.2 % of patients followed the recommended self care

practices. Diet and medication taking were the most practiced self care behaviours by 57.7%

and 78.4 % of patients respectively. Only 25.7 % exercised for 30 minutes per day and 42.3

% did not have a blood glucose measurement within 3 days prior to participating in the

study. Baumann et al(23) in Kampala, Uganda showed that patients did believe that diabetes

is a serious chronic illness that required practice of certain behaviors in order to manage the

disease. However, self care behavior which was assessed using a modified version of the

Diabetes Self Management Assessment Tool (DSMART) was found to be poor. Dietary

measures were the most practiced self care practice with up to 88% of patients able to limit

fatty foods. 38% of patients had a regular program of exercise. Only 15% of patients were

able to monitor their blood glucose at home citing financial constraints in obtaining a

glucometer but could have access to glucose monitoring at a nearby health facility. The

most frequently identified self care goals were to exercise more and to make better food

choices both at 23%. This therefore emphasizes the need to evaluate each population in

order to make recommendations that are sensitive and relevant.

Few research studies have focused on the factors that contribute to poor knowledge level and adherence

to the recommended diabetes self care practices which are significant for improving diabetic outcome.

This research aims to address the lack of understanding regarding the management of diabetes and

19
adherence to diabetes self care practices among women living with type II diabetes and above 50 years

of age.

Chapter Three– Research Methodology

3.1Study Area

3.2Study Design

A cross- sectional research design will be used.This design will be ideal for such a study because

sampling from a specific population is done at one point. The design will enable data collection under

natural settings and is in a relatively cheaper and quicker to undertake and the results will infer a larger

population. Its application will allow collection of both qualitative and quantitative data from diabetic

clinic. The descriptive survey research will obtain information that describes existing phenomena by

asking individuals about their attitudes, perceptions, hehaviours, knowledge and practices and also will

allow findings of this study to be presented through simple statistics, tables, percentages and frequency

distribution (Mugenda and Mugenda,2003)

3.3Inclusion Criteria

All women aged 59 years and above, diagnosed with type II diabetes mellitus, who will be willing to

participate in the study will be included

3.4Exclusion criteria

Women aged 50 years and above, diagnosed with type II diabetes mellitus, who will be absent during

data collection and who will be unwilling to participate in the study will be excused.

20
 3.5 Study Population

Researcher targets women aged 50 years and above attending diabetic clinic at thika level 5 hospital,

kiambu county. According to Cooper and Schindler (2000) a sample size is the subject of population to

be studied. To ensure the sample accurately represents the pollution of the study , it's important for the

researcher to clearly define the characteristics of the population, determine the sample size and to choose

the best method for selecting number of the sample from the larger population. According to health

records the estimated number is 50.

In this study, the researcher will therefore determine the sample size using the following method; sample

size will be derived from target population and the following formula will be applied as used by fiseher

et al 1988.

N=PQ

D2

Where;

N= the desire sample size ( if the target population is greater than 10,000)

Z= the standard normal derivation at required confidential level cusually set at 1.96 which corresponds to

95% confidence level

P= the proportion in the target population estimated to have characteristics being measured

D2 = the level of statistical significance or degree of acurac desired usually set at 0.05 level

Therefor ; Z2 = 1.962

D = 0.5%
21
 Q= 0.d(1-0.5)

D2= 0.052

When n = z2pq

D2

N = 1.962 X 0.5(1-0.5)

0.052

N = 384.I6 ROUNDED OFF to 384

N = 384

Formular of calculating the final sample estimate (nf) is

Nf= n

Nf=1+n

nf = the desired sample size (where population is less than 10,000

n= the desired sample size ( wherepopulation is less than 10,000)

n= The estimate of the population size, 50 , in information from diabetic clinic records

Therefore

Nf=1+n

Where N = 50

Nf = 384
22
 1+384

50

Nf = 384

1+7.84

Nf = 44.23

Sample size of 44 respondents.

3.6Data collection procedure

Data will be collected using questionnaires including open and closed questionnaires in respect to the

study objectives in simple English so that every participant can be able to understand.

3.7 Data collection tools

Simple English structured questionnaires will be used I. The process of data collection where it will be

understood by all participants. The data will also be obtained by interviewing the women age 50 years

and above attending diabetic clinic at thika level 5 hospital, the questionnaire will obtain three parts.

3.8 Study Limitations

Due to financial constraints and limitation of time and resources, I the researcher may not be able to

reach all the target population.

3.9 Data management, analysis techniques and presentation.

The collected data will be edited, coded and analyzed by use of calculation manually. Raw data will be

classified into several categories analyzed through Ms excel when it is completed. Data will be presented

using pie charts, tables figures and percentages.

23
3.1.0 Ethical considerations
The permission to carry out the study will be granted by Kenya medical training college thika campus

and the medical superintendent and the nursing officer in charge of the diabetic clinic at thika level 5

hospital.

The letter will be written from college to the administration of thika level 5 hospital to give me the

permission to carry out the study in the hospital.it will also serve as an introduction letter explaining the

purpose of my study to the respondents so as to obtain an informed consent from them.

The participants will be given an opportunity to have their concerns addressed before participating. It is

within the participants rights to participate in the study and it's within their rights of those who decline to

have equal access to the health care compared to those who accepted. During the data collection

procedure confidentiality and respect will be maintained throughout the research process. Anonymity

will be ensured. There will be use of identification numbers on their questionnaires. Go

24
Chapter four

Data Analysis, Presentation and interpretation

4.1Introduction

This chapter presents analyses the findings of the study as set in the research methodology. A study that

aims at investigating knowledge, attitude and practices in self care management of diabetes type II

among women 50 years and above attending diabetic clinic at Thika level 5 hospital, Kiambu county.

The study targeted a sample of 44 respondents. Out of the 44, 40 participated by completing and

returning the questionnaire and this was 90.0% response rate. This response rate was sufficient and

representative and conforms to Mugenda and Mugenda ( 2003) stipulation that a response rate of 50% is

adequate for reporting and analysis. This commendable reponse rate was due to the constant reminder to

the respondents to fill in and return questionnaires.

4.2 Demographic Data

Table 1; sex of the respondents

Ange in Years No of Respondents Percentage

50 – 55 years 8 20%

55-60 years 21 52.5%

60 – 65 years 7 17.5%

65 Years and above 4 10%

Total 100 100%

The findings from the table above shows that most of the respondents 20% were aged between 50-55

years. 52.5% were aged between 55-60 years. 17.5% were aged 60-65 years and 10% were aged 65 and

above years.
25
4.2.2 Table II: Level of education of the respondents

Education Level Number of Respondents Percentage

Primary 24 60%

Secondary 5 12.5%

College 3 7.5%

University 2 5%

No formal education 6 15%

TOTAL 100 100%

The results from the table above shows that majority of the respondents have attained primary level of

education at 60% followed by no formal education at 15%.

Secondary level at 12..5% while college level at 7.5% and university level at 5%. This indicates or

creates an impression that most of the respondents are literate and likely to take up the services offered in

the diabetic clinic with ease with the assumption they are exposed.

26
4.2.3 Respondents Source of income

Histogram 1
50%

45%

40%

35%

30%
Histogram 1
25%

20%

15%

10%

5%

0%
Retired or pension Small scale farmers Self employed but formal employment
not farmers

RESPONDENTS SOURCE OF INCOME

The results from the histogram above shows that majority of the respondents at 45% were retired or on

pension 35% were small scale farmers, 15% were self employed but no farmers and 5% were in formal

employment

4.2.4 Respondents Religion

27
 Histogram 2
80%

70%

60%

50%
Histogram 2
40%

30%

20%

10%

0%
Christians Muslims Hindu Others

Respondents Religion

The histogram above shows majority of the respondents 67.5% were Christians while 27.5% were

muslims 5% were hindus. There was no other religion among the repondents. This indicated tha majority

of the respondents had a place to worship and their religious beliefs that could have contributed to the

factors hindering their management.

4.3 Knowledge on self care management of diabetes type II among women ove 50 years of age

4.3.1 Constotuents involved in the self care management of diabetes type II

28
 Histogram 3
80%

70%

60%

50%

40% Histogram 3

30%

20%

10%

0%
Blood glucose Special diet Exercise Foot care I don’t know
control and mon-
itoring

Constituents of self care management of diabetes II

The histogram above shows majority of the respondents are aware of the constituens involved in self care

management of diabetes type II 70% had knowledge on blood glucose control and monitoring. 17.5%

had knowledge on following a special diet, 5% exercise and also 5% foot care. 2.5% of the respondents

had no knowledge on the constituents involved in self care management of diabetes type II

4.3.2 Knowledge about effect of exercise on blood glucose

Chart 1

29
 Chart one

Lowers blood glucose I don’t know no effect raise blood glucose

The results from the pie chart above shows majority of the respondents about 37.5% have knowledge

that exercise lowers blood glucose, 30% of the respndents do not know if exercise has effect on blood

glucose. 20% of the respondents know that exercise raises blood glucose and 12.5% of the respondents

know that exercise has no effect on blood glucose

4.3.3 Knowledge of the normal fasting range for blood glucose

Table III

Fasting blood glucose level No of respondents Percentage

3.9 – 5.6mmol/l 14 35%

4.4-6.1 mmol/l 16 40%

7.0- mmol/l 3 7.5%

I don’t Know 7 17.5%

TOTAL 100 100%

30
The table above indicates the respondents perceptions about fasting range of blood glucose. 40% of the

respondents indicates 4.4-6.1 mmol/l, 35% of the respondents indicated 3.9-5.6 mmol/l. 7.5% of the

respondents indicate 7.0-10.0 mmol/l and 17.5% of the respondents did not have knowledge of the

fasting range for flucose

4.3.4 Knowledge of frequency of checking feet for 5ores or red sports

Chart one

I don’t check Once a month everyday once a week

The pie chart indicates that majority of the respondents 72.5% do not check their feet for scores or red

sorts 15% of the respondents check their feet for sores once a month , followed by 7.5% once a week and

only 5% of the respondents check there feet for sores or red sports everyday.

4.4 ATTITUDE TOWARDS SELF CARE MANAGEMNT OF DIABETES TYPE II

4.4.1 Respondents attitude towards self care practices curing diabetes mellitus type II

31
 Histogram 4
80%
70%
70%

60%

50%
Histogram 4
40%

30%

20% 18%

10%
10%
3%
0%
Agree Strongly agree I don’t know Disagree

The histogram above indicates majority of the respondents 70% agree self care practices can cure

diabetes melltus 17.5% strongly agree followed by 10% of the respondents don’t know. 2.5% of the

respondents disagree selfcare practices can cure diabetes. None of the respondents believe self care

practices can cure diabetes mellitus II

32
4.4.4 Respondents control of blood glucose levels

Chart III

Inject Insulin Exercise

Take tablets for diabetes Follow a special diabetes diat

The pie chart indicates majority of the respondents 45% inject insulin to control lood glucose levels

followed by 37.5% who take tablets to control blood glucose levels. 12.5% of the respondents follo a

special diet t control glucose level followed by 5% who exercise . none of the respondents indicated

doing nothng to control diabetes

4.4.3 Attitude of respondents towards stopping drugs after control of blood glucose

33
 Chart IV

18%

13%

70%

Yes No Don’t know

The pie chat above indicate majority of the respondents 70% agree drugs should not be stopped once

blood glucose has been controlled. 17.5% of the respondents agress drugs should be stopped once there

us control of blood glucose

4.5 Self Care management practices of diabetes Type II

4.5.1 Respondents owning blood glucose meter for self care management of diabetes type II

34
 Chart V

30%

70%

Yes No

The pie chart above indicates majority of the respondents 70% own a blood glucose meter ( glucometer)
30% of the respondents indicate they do not have a blood glucose meter.

4.5.2 Respondents place of measuring blood glucose if not owning a personal glucometer

Histogram 5
50%

45% 43%

40%

35% 32%
30%
Histogram 5
25%
21%
20%

15%

10%

5% 4%

0%
Pharmacyl Chemist Health care Private hospital Provincial hospital

35
Respondents place of measuring blood glucose

The histogram above indicates a majority of the respondents who do not have a glucose meter at home,

regularly measure their blood glucose, 43% of the respondents measure at a pharmacy or chemis 32% of

the respondents measure at a health center, 35% of the respondents who measure at a provincial hospital

4.5.3 Frequency of checking blood glucose

Histogram 6
70%

60% 58%

50%

40%
Histogram 6

30%
23%
20%
13%
10%
5%
3%
0%
A few times a Once a week Once a month Twice a day I don’t check
week

The histogram above indicates 57.5% of the respondents check their blood glucose a few times a week ,

22.5% of the respondents check blood glucose once a week followed by 12.5% of the respondents check

their blood glucose twice a day. 2.5% of the respondents do no check their blood glucose levels. None of

the respondents check glucose twice a day.

36
Chapter five – Discussion and Interpretation

5.1Introduction

This chapter discussed the findings in line with specific objectives and compares the study findings with

other studies carried out in other places and countries worldwide. The analyzed results are from a sample

of 40 clients.

5.2 Discussion on how level of knowledge affects self care management of Diabetes

The first objective of this study was to assess the awareness levels of the patients regarding diabetes

management. 70% of the respondents had moderate levels and 30% had low awareness. The findings are

consistent with a similar study by ( keram et al , 2012) that found that two thirds of the patients we aware

of diabetic management.

Improving patients knowledge on self care management of diabetes will allow to better contribute to

their care. Study shows that intensive diabetes education and care management can improve patient

outcome, glycemic control and quality of patient care (Mc Murray et al , 2010) The study agress with

( Ahmed Islahutin, 2014) that proper management of diabeteis entails good glycemic control including

constant health education among diabetes patients on importance of adhering to nutrition, exercise,

smocking cessation and treatment. During the cause of this study, it was noted that diabetes education

takes place weekly at the clinics. This is a barrier to those patients who do not have necessary funds to

facilitate their transportation on that particular day. A shortage of nurses also hinders effective delivery

of diabetes self management education to patients. (MC Murray et al, 2010)

With poor knowledge the quality of self care is poor and this is significantly associated with high

morbidity and mortality levels. People living with diabetes have a reduction of quality of life because

they undergo changes in their life habits and have disease related probles (Seulen et al, 2017)

37
 5.1 Discussing on attitude towards self management of diabetes type II.

The study established that majority 70% of the respondents had the right attitude towards self care

practices curing diabetes type II. The study findings showed 2.5% of the respondents disagreed that

self care can cure diabetes . The study established 45% of the respondents inject insulin to control

blood glucose levels followed by 37.5% of the respondents who take tablets to control blood glucose

levels. None of the respondents indicated doing nothing to control blood glucose levels. This implied

that majority of the women over 50 years and above had the right attitude towards self care

management due to their knowledge on constituents in self care management of diabetes including

blood glucose control and monitoring, following a special diet , exercise and knowledge on foot care.

The study established that 70% of the respondents agreed that drugs should not be stopped once

blood glucose has been controlled. 17.5% of the respondents agreed that blood should be stopped

once blood glucose has been controlled. The results are consistent with a similar study that showed

that most of the patients felt that they had a good understanding of diabetes and were compliant with

their medical regimen. Although most of the patients expressed strong emotions of frustration and

anger. They were les likely to want further information from their physician and less likely to report

following their physician instructiions. It concluded that a better understanding of patients beliefs and

attitude may help physicians increase motivations understanding and compliance of diabetic patients

(EC Mc cord and C Brandenburg, 2007)

5.3How self Care Management Prectices affect diabetes management

In this study 54% of the respondents had a moderate seeking of self management practices, 38% had self

management practices . similar results were found in the other studies for instance 30% had high self

behaviour in a study by Myanmar (Sandhi, 2012) knowledge is an important contribution factor

behaviour change but is not sufficient on its own ( Rosentock et al, 2011)
38
In this study awareness of the respondents about self management was moderate however, majority of

them did not follow recommended self practice.

This may be associated to factors such as less perceived severity of the disease and its complications, low

income status which is supported by the study done in Nigeria , Adibe,2011. In the shudy 45% of the

respondents were retired and 35% were small scale famers followed by 15% who were self employed but

not farmers. This indicates most of respondents lacked a stable source of income hence contributing to a

moderate seeking of self management practices.

39